0494 Sleep Related Respiratory Events on Buprenorphine Compared to Naltrexone

Abstract Introduction Opioid medications are associated with an increased risk of sleep related respiratory events, especially central apneas. However, the potential impact of partial agonists (buprenorphine) and full antagonists (naltrexone) is less well known. In this study we hypothesize that patients using buprenorphine will have a greater prevalence of central apneas and require more frequent use of bilevel PAP therapy than those using naltrexone. Methods We performed a retrospective chart review of patients in a sleep laboratory database identifying patients who were prescribed naltrexone or buprenorphine at the time of a diagnostic PSG or PAP titration between 2019 and 2023. We only included initial diagnostic studies and initial titrations. The patients were split into four groups (buprenorphine/diagnostic, buprenorphine/titration, naltrexone/diagnostic, naltrexone/titration). Polysomnograms (PSG) were performed and scored in accordance with AASM guidelines. The Epworth Sleepiness Scale (ESS) and standard PSG variables were collected, and group differences were analyzed. Statistical significance was determined using a two-tailed T test. Results A total of 87 patients and 114 studies were included (n= 43 buprenorphine/diagnostic, n=25 buprenorphine/titrations, n=22 naltrexone/diagnostic, n=24 naltrexone/titration). Overall average age was 48 years, with 60.5% female. No significant difference of age or gender was found between the groups. All groups had high rates of underlying hypertension, depression, anxiety, and substance use disorders. Patients on buprenorphine were subjectively sleepier and demonstrated more frequent sleep-related respiratory events. Patients on buprenorphine presenting for initial diagnostics had higher ESS scores (11.1 vs. 7.14, p=0.017), and higher sleep efficiency (87.3% vs. 78.6%, p=0.045). The buprenorphine group had higher mean AHI (18.0 vs. 8.62, p=0.008) and more central apneas per hour, but this did not meet statistical significance (5.21 vs. 1.81, p=0.12). In the PAP titrations, patients on buprenorphine had more difficult titrations and a greater proportion of the buprenorphine group failed CPAP and required bilevel PAP. Conclusion Our cohort demonstrates a higher degree of subjective sleepiness, a tendency toward more central apneas, and increased likelihood to fail CPAP and require bilevel PAP in patients prescribed buprenorphine. We believe clinicians should have a higher degree of suspicion for central apnea in patients who are prescribed partial opioid agonists. Support (if any)